1
Q
What is the appropriate ratio of the long and short axes for elliptical incisions?
A
0.167361111111111
2
Q
Generally, what size defects of the lower lip can be closed primarily?
A
3
Q
What is the most common reason for rhinoplasty revision?
A
Polly beak deformity or supratip swelling.
4
Q
What is the primary blood supply of the deltopectoral flap, temporal, forehead, and nape of neck cutaneous flaps?
A
- DeltopectoralInternal mammary arteries.
- Temporal-Superficial temporal artery.
- Forehead-Supraorbital and supratrochlear arteries
- Nape of neck-Random (postauricular, occipital vertebral arteries).
5
Q
What are five lower lid blepharoplasty techniques that help prevent postoperative retraction?
A
- Horizontal alignment of lower lid incisions.
- Preservation of a strip of orbicularis attached to the tarsal plate.
- 3•Draping of the flap medially and superiorly.
- 4• Placement of a suspension suture between the deep surface of the orbicularis and the orbital periosteum.
- 5•Triamcinolone injection into plane of orbital septum.
6
Q
What are the five stages in the repair of third-degree microtia?
A
- I-Auricular reconstruction.
- II-Lobule transposition.
- III-Atresia repair.
- IV-Tragal construction.
- V-Auricular elevation.
7
Q
What are the reconstructive options when the mandibular condyle must be removed during tumor resection?
A
- Incompletely reconstruct the ramus so that it does not extend as high as the glenoid fossa.
- Attach a prosthetic condyle to the flap.
- Shape the end of the flap to simulate the condyle.
- Use the resected condyle as a nonvascularized graft mounted onto the end of the flap with a miniplate.
8
Q
At what age is cleft palate repair performed?
A
>6 months.
9
Q
What do “microplates” refer to?
A
1.0 mm screw applications.
10
Q
How long does it take for hair to start growing after transplantation?
A
10-16 weeks.
11
Q
How many hairs are contained in a micrograft?
A
1-2.
12
Q
Where should subperiosteal undermining begin during brow lift?
A
2.5 cm above the lateral orbital rim to avoid injury to the supraorbital nerve.
13
Q
What is the best method of reconstruction for defects between 1/2 and
A
2/3 of the lower lip, not involving the oral commissure? Abbe-Sabattini flap.
14
Q
What postorbital fracture visual acuity scores are associated with a return to normal acuity after treatment?
A
20/400 or better.
15
Q
At what age is lip adhesion performed?
A
2-4 weeks of age.
16
Q
‘What is the typical long-term interincisal opening after surgical correction of TMJ ankylosis?
A
25-28 mm.
17
Q
What percent of patients develops herpes simplex virus (HSV) despite antiviral prophylaxis?
A
2-7%.
18
Q
What is the incidence of positive responses to skin tests for injectable collagen?
A
3%.
19
Q
What percent of patients develops postinflammatory hyperpigmentation?
A
33% (more for darker skin types).
20
Q
Where should dissection of the tarsoconjunctival flap begin in relation to the eyelid margin?
A
3-4 mm superior to the lid margin.
21
Q
How long does injectable collagen remain in the tissue?
A
3-6 months.
22
Q
How many hairs are contained in a minigraft?
A
3-8.
23
Q
How much time should be allotted between transplantation sessions?
A
4 months.
24
Q
At what age is pharyngoplasty typically performed?
A
4 years.
25
How far posterior should dissection proceed when placing a porous polyethylene implant for defects of the posterior convex orbital floor?
4cm.
26
When does hypopigmentation after laser skin resurfacing present?
6-12 months after treatment.
27
What are the indications for endoscopic optic nerve decompression after facial trauma?
66% reduction in amplitude of the visual-evoked response, loss of red color vision, bony impingement on the optic canal, and afferent papillary defect.
28
What percent of patients develops contact dermatitis after laser resurfacing?
6s%.
29
What is the average gain in soft-tissue projection after implant placement?
70% of the size of the implant.
30
How is infection managed after chin implantation?
A 10-day course of antibiotics is given, and if the infection does not resolve, the implant should be removed. If a microporous implant is used, the implant is removed without delay.
31
What complication will occur if the above ratio is not met?
A dog-ear deformity.
32
What are the key features of the Millard cleft lip repair?
A medial rotation flap to align the vermillion, a triangular C flap to lengthen the columella, and an advancement flap to close the upper lip and nostril sill.
33
What is lip adhesion?
A preliminary step in cleft lip repair where a complete cleft lip is converted into an incomplete cleft.
34
What should be incorporated into the flap to promote viability of the skin paddle?
A small cuff of soleus and flexor hallucis longus muscle.
35
What is the most common cause of lower lid retraction after blepharoplasty?
Accumulation of small amounts of blood in the middle lamellar plane.
36
When should micro- and minigrafts be placed in relation to flap or reduction procedures?
After the flap or reduction procedures have healed.
37
What is the ideal age for unilateral microtia correction?
Age 6.
38
What is the most important factor in the aesthetic outcome of lip reconstruction?
Alignment of the vermillion border.
39
What is the safest plane of dissection in the malar region?
Along the superficial surface of the elevators of the upper lip (zygomaticus major and minor).
40
Where in the midface is the facial nerve most vulnerable during SMAS undermining?
Anterior to the parotid gland.
41
What does the converse technique attempt to reconstruct during surgery for the prominent ear?
Antihelix of the auricle.
42
What are the contraindications to primary closure of bites?
Any human bite; animal bites seen after 5 hours of injury; all avulsion injuries from any animal bite.
43
On average, how much skin is perfused by the peroneal artery in the Fibular free flap?
Approximately 10 x 21 cm.
44
Where should the vascular pedicle lie on the new mandible?
As close as possible to the new mandibular angle.
45
How much time should be allotted before removing an implant due to improper size?
At least 3 months.
46
How much cartilage should be preserved during a complete strip procedure?
At least a 4-5 mm strip or 75% of the original cartilage volume.
47
Where are inferiorly positioned plates placed?
At the inferior border of the mandible to avoid the neurovascular bundle.
48
Which major tip support mechanism is violated by the inter- and transcartilaginous incisions?
Attachment of the caudal edge of the upper lateral cartilages to the cephalic edge of the alar cartilages.
49
Which major tip support mechanism is violated by the complete transfixion incision?
Attachment of the medial crura to the caudal septum.
50
Which reconstructive options when the mandibular condyle must be removed during tumor resection is optimal?
Autologous condyle transplantation as it preserves occlusion, TMJ function, and vertical facial height without increasing morbidity.
51
How wide are the Burrow's triangles designed?
Bases are equal in width to 1/2 of the lip defect.
52
What is the treatment for a nondisplaced posterior table fracture with a CSF leak?
Bed rest with head elevation +I- lumbar drain; cranialization considered if not resolved after 5-7 days.
53
What is the general approach for repair of panfacial fractures?
Begin laterally, work medially, and correct NOE and nasal septal fractures last; frontal fractures should be repaired before midface fractures.
54
What is the general approach to repair LeFort III fractures?
Begin stabilization at the cranium then work caudally.
55
When is alveolar bone grafting typically performed in patients with cleft palate?
Between ages 9 and 11.
56
In what region is division of the frontalis muscle prohibited?
Between the lateral brow and the temporal hairline.
57
Between which layers of the scalp are tissue expanders placed?
Between the periosteum and the loose areolar tissue.
58
How is contact dermatitis after laser resurfacing treated?
Bland emollients (avoid topical antibiotics), topical class I corticosteroids, cool and wet compresses.
59
Which injectable fillers require a skin test prior to use?
Bovine collagen fillers (Zyplast and Zyderm).
60
What is the best method of reconstruction for defects involving 2/3 or more of the upper lip?
Burrow-Dieffenbach +I- Abbe-Sabattini flap.
61
What if the skull is involved?
Can use a split calvarial, split rib, or methyl methacrylate plus latissimus dorsi flap.
62
Reduction of what structure accomplishes the majority of profile changes in patients requesting reduction rhinoplasty?
Cartilaginous dorsum.
63
What is the one way to improve the stability of a columellar strut?
Carve the base into a V or fork or rest a large strut on a cartilage platform (plinth).
64
What are the major adjunctive procedures for tip rotation?
Caudal septal shortening, upper lateral cartilage shortening, high septal transfixion with septal shortening, and reduction of convex caudal medial crura.
65
Why should a rhomboid flap not be used to close a scalp defect?
Causes improper orientation of the hair.
66
What is the most feared complication of otoplasty?
Chondritis.
67
What is a V-Y advancement flap?
Closure of a rectangular defect by incising an adjacent triangle of tissue and advancing it into the defect.
68
What are the complications of radical septal resections?
Columellar retraction, dorsal saddling, airway collapse, increased nasal width, loss of tip support, and septal perforation.
69
What is a pixie or satyr earlobe?
Common complication of rhytidectomy where the earlobe is elongated and directly attached to the facial cheek skin.
70
What are the minor adjunctive procedures for tip rotation?
Complete transfixion incision, wide skin sleeve undermining, excision of excessive vestibular skin, proper tip taping, plumping grafts, columellar strut, division of the septi depressor muscle.
71
What are the different approaches used in septoplasty?
Complete, partial, hemi- and high transfixion incisions.
72
Which mandible fractures require ORIF with bicortical screws?
Complex open fractures that are displaced, comminuted, or infected.
73
Rigid fixation is based on what two means of stabilization?
Compression and splinting.
74
Why should compression plates be overcontoured by 3 degrees to 5 degrees?
Compression at the buccal surface tends to produce spreading on the lingual side; overcontouring will overcome this.
75
What problems can occur if a lateral mandibular defect is not reconstructed?
Contour deformity of the lateral lower 1/3 of the face, displacement of residual mandible toward the side of the defect, malocclusion.
76
What is the "workhorse" for exposure of the nasoethmoidal region?
Coronal approach.
77
What can be done for trismus that does not respond to brisement force?
Coronoidectomies.
78
What is the indication for surgical treatment of isolated anterior table fractures?
Cosmetic deformity.
79
How does release of the arcus marginalis affect eye contour?
Creates a more convex, youthful eye contour.
80
What is the primary disadvantage of lip adhesion?
Creates scar tissue that can interfere with definitive repair.
81
What are the potential complications of endoscopic optic nerve decompression?
CSF leak, carotid artery injury, transection of the ophthalmic artery, and orbital fat herniation.
82
What technique is ideal for repair of large full-thickness defects of the upper lid?
Cutler Beard or Bridge procedure.
83
What is a potential complication of this approach?
Damage to the temporal fat pad, resulting in temporal wasting.
84
What effect does the complete transtlxion incision have on tip projection and rotation?
Decreases tip projection and increases tip rotation (resulting in nasal shortening).
85
What vessels is the iliac crest free flap based on?
Deep circumflex iliac vessels.
86
What vessels is the rectus abdominus free flap based on?
Deep inferior epigastric vessels.
87
Which approach to rhytidectomy improves the nasolabial folds?
Deep plane rhytidectomy.
88
What is the primary blood supply to the temporalis muscle flap?
Deep temporal artery.
89
What is the proper plane of dissection during rhinoplasty?
Deep to the subcutaneous tissue and SMAS layers.
90
What effect does SMAS suspension have on the nasolabial folds?
Deepens them.
91
What are the two major approaches to tip surgery?
Delivery and nondelivery.
92
What other factors increase the risk of scarring?
Development of wound infection or contact dermatitis, recent use of isotretinoin, history of radiation therapy, and history of keloids.
93
What is the significance of the position of the hyoid bone in rhytidectomy?
Dictates the maximum improvement possible in the cervicomental angle; ideal position is high and posterior.
94
What is the major limit of microsurgical reconstruction in this area?
Difficult to restore normal contour.
95
What are the three approaches to zygomatic arch fractures?
Direct percutaneous, temporal (Gillies), and hemicoronal approaches.
96
What is the treatment of choice for an edentulous 40-year-old epileptic man who sustains a LeFort I fracture during a seizure?
Direct wiring of the zygomaticomaxillary buttresses.
97
What is the most likely cause of dimpling of the skin following liposuction of the jowls?
Directing the opening of the extractor toward the skin.
98
When is cranialization required for treatment of frontal sinus fractures?
Displaced posterior table fractures with a CSF leak or significantly comminuted posterior table fractures.
99
What are the indications for frontal sinus obliteration in the presence of a fracture?
Displaced posterior table fractures with involvement of the nasofrontal duct.
100
What is the most likely cause of cyclovertical diplopia following repair of a NOE fracture?
Disruption of the trochlea.
101
What can be done for the patient whose lateral crura are concave?
Dissect lateral crura completely free and reverse them 180 degrees.
102
When approaching the frontozygomatic buttress through the hemicoronal incision, how is the temporal branch of the facial nerve avoided?
Dissection begins just superficial to the superficial layer of the deep temporal fascia; 2 cm above the zygomatic arch, the dissection is carried deep to the superficial layer of the deep temporal fascia.
103
What is the plane of dissection with the Gillies approach?
Dissection is carried out between the temporalis muscle and its overlying fascia.
104
What is the significance of the timing of palatal repair on midfacial growth and speech?
Earlier repair is associated with better speech but midface retrusion; later repair is associated with worse speech but minimal midface retrusion. More evidence exists to support the importance of timing on speech than on midface retrusion.
105
What are the only plates that can bear the stress of mastication during healing?
Eccentric dynamic compression plates.
106
Patients who have previously undergone blepharoplasty are at increased risk for which complication after laser skin resurfacing?
Ectropion.
107
The greater omentum axial flap is based on what vessels?
Either the right or the left gastroepiploic artery.
108
What is the most common complication after orbital reconstruction?
Enophthalmos.
109
Which rotation flap is best suited for lateral defects of the lower lip?
Estlander flap.
110
What is the best flap for defects of the oral commissure?
Estlander flap.
111
What is the most common complication of submental liposuction?
Excessive submental wrinkling.
112
What are the four ways to correct hypertrophic or wide scars?
Excision/undermining, Z-plasty or W-plasty, geometric broken line closure, and dermabrasion.
113
What is the primary advantage of the eyelid margin graft?
Eyelash replacement.
114
What four composite grafts can provide both rigidity and a mucosal surface for eyelid reconstruction?
Eyelid margin graft, tarsoconjunctival graft, nasal chondromucosal graft, and hard palate mucoperiosteal graft.
115
To which vessels can the peroneal artery be anastomosed?
Facial or external carotid artery.
116
What is the best material for dural reconstruction?
Fascia lata.
117
What materials can be used to obliterate the frontal sinus?
Fat, muscle, fascia, or cancellous bone; can also allow spontaneous osteogenesis after burring the inner cortices.
118
What is the optimal flap for reconstruction of anterior mandibular defects?
Fibular free flap (FFF).
119
When do most major hematomas occur after rhytidectomy?
First 12 hours postoperatively.
120
Your patient has a fracture of the mandibular body and a comminuted midface fracture. How do you approach reconstruction?
First MMF, then ORIF the mandible, then ORIF the midface.
121
Your patient has a fracture of the condylar head and mandibular body and a comminuted midface fracture. How do you approach reconstruction?
First ORIF the midface, then place the patient into MMF, then ORIF the mandibular body fracture.
122
What are the best flaps for through-and-through cheek or oral cavity defects?
Folded Fibular free flap or double paddle scapula flap.
123
When should lag screws be used to reduce a fracture?
For an oblique fracture with an intact inner fragment where the length of the fracture is at least twice the thickness of the bone.
124
When are serial explorations indicated after penetrating injuries to the face?
For high-energy gunshot or rifle (\>1200 ft/s) injuries, shotgun injuries, and high-energy avulsion injuries.
125
For which types of clefts is the double reversing Z-plasty best?
For narrow soft palate clefts and submucous clefts.
126
'What is brisement force?
Forced jaw opening under anesthesia; usually successful for treatment of trismus that does not respond to physiotherapy.
127
How many stages are required for completion of the Juri flap?
Four stages.
128
What are the absolute indications for surgical repair of frontal sinus fractures?
Fractures involving the nasofrontal duct and significantly displaced posterior table fractures with or without dural tear and CSF leak.
129
What is the primary advantage of using a soft tissue free flap over a pectoralis major flap in conjunction with a mandibular plate?
Free flap results in a much lower rate of plate exposure.
130
What flaps are ideal for reconstruction of extensive scalp defects?
Free latissimus dorsi surfaced with nonmeshed split-thickness skin graft; if entire scalp is involved, latissimus dorsi with serratus anterior.
131
What material is used for grafting?
Fresh autogenous particulate marrow.
132
Alopecia in which area of the scalp is not improved by scalp reduction?
Frontal.
133
Reduction of which buttresses is essential to restore upper facial width?
Frontozygomatic buttresses.
134
What happens to the position of the globe when 2.5 cc of fat is removed?
Globe moves 1mm inferiorly and 2 mm posteriorly.
135
What is the most commonly injured nerve during rhytidectomy?
Greater auricular nerve.
136
How wide should the Abbe-Sabattini flap be?
Half the width of the defect.
137
What is the most common complication of rhytidectomy?
Hematoma.
138
What are the three approaches to the frontozygomatic buttress?
Hemicoronal, lateral brow, and the upper blepharoplasty incisions.
139
Which of these is preferred when the anatomy of the tip-infratip lobule and related structures is ideal?
High septal transfixion with septal shortening.
140
What technique is ideal for reconstruction of large posterior lamella defects of the lower eyelid?
Hughes tarsoconjunctival flap.
141
Which type of injectable fillers can be diminished with hyaluronidase in the case of over augmentation?
Hyaluronic acid derivatives (Restylane, Juvederm, Captique).
142
What treatments can be used to help this problem?
Hydroquinone or retinoic acid plus a topical class I corticosteroid, glycolic acid.
143
What is the best method of reconstruction for defects involving 2/3 or more of the lower lip?
If centered in the midline, the Webster modification of the Bernard-Burrow repair.
144
When is diplopia likely to persist after orbital reconstruction?
If diplopia occurs within 30 degrees of the primary position.
145
What is the significance of the labiomental fold in chin implantation?
If the fold is high, implantation can enlarge the entire lower face.
146
Which types of osseous free flaps allow enosseous dental implants?
Iliac crest, scapula, fibula, and radius.
147
What is the difference between SMAS imbrication and SMAS plication?
Imbrication involves undermining and cutting the SMAS prior to suspension; plication involves folding the SMAS on itself.
148
Why is the gain reduced?
Implant settling, bone resorption, and soft-tissue compression.
149
In which patients are sliding genioplasty indicated?
In patients with excess or insufficient vertical mandibular height, extreme microgenia, hemifacial atrophy, or mandibular asymmetry and in those who fail alloplastic chin augmentation.
150
When can the transcartilaginous incision not be used?
In patients with widely divergent intermediate crura where the domes need exposure for narrowing.
151
When does midface retrusion present in children with cleft palate?
In the teenage years when the growth spurt occurs.
152
How does the facelift incision differ between men and women?
In women, the incision runs along the posterior margin of the tragus (posttragal); in men, the incision is placed in the preauricular crease (pretragal) so that facial hair does not grow on the tragus postoperatively. Also, a margin of non-hair-bearing skin is preserved around the inferior attachment of the earlobe in men.
153
What is the most common complication of otoplasty?
Inadequate correction.
154
What is the most common cause of loss of vision after reduction of facial fractures?
Increased intraorbital pressure, usually secondary to venous congestion.
155
What are the disadvantages of the retroseptal approach?
Increased risk of injury to the inferior oblique muscle and prolapse of orbital fat into the surgical field.
156
What are the most common causes of delayed healing and nonunion after repair of mandible fractures?
Infection and noncompliance.
157
The "zone of compression" refers to which area of the mandible?
Inferior border of the mandible.
158
Identification of what structure is essential in safely exposing the medial and central fat pads during a transconjunctival lower eyelid blepharoplasty?
Inferior oblique muscle.
159
Which anatomic areas are more prone to scarring after laser treatment?
Infraorbital area, mandible, and anterior neck.
160
What is isolagen?
Injectable autologous soft tissue material derived from cultured human fibroblasts.
161
What are the contraindications to orbital exploration after orbital trauma?
Injury to an only-seeing eye; presence of hyphema, globe injury, or retinal tear; and medical instability.
162
Which incisions can be used for exposure and delivery of the alar cartilages?
Intercartilaginous and marginal incisions.
163
What are the three primary incisions used in tip surgery?
Intercartilaginous, transcartilaginous, and marginal incisions.
164
Which technique results in greater cephalic tip rotation: interrupted or complete strip?
Interrupted strip.
165
What is the Goldman technique for increasing tip projection?
Interrupted strip; borrowed cartilage from the lateral crus is sutured into the medial crus, resulting in elongation of the medial crura.
166
What are the indications for pharyngoplasty after cleft palate repair?
Intractable VPI not responsive to speech therapy.
167
What can be used to treat scarring after laser skin resurfacing?
Intralesional or topical corticosteroids, 585 nm pulsed-dye laser (two to three treatments at 6-8 weeks intervals).
168
What is the term for repair of the levator veli palatini muscle during cleft palate repair?
Intravelar veloplasty.
169
What are the major advantages of the Millard repair?
It preserves cupid's bow and the philtra! dimple, and by placing the tension of closure under the alar base, it reduces flare and promotes improved molding of the underlying alveolar process.
170
Why is the Fibular free flap optimal for reconstruction of mandibular defects?
It provides enough length to reconstruct any size defect, can be harvested in the supine position and in tandem with tumor resection, has low donor site morbidity, and provides soft tissue for intraoral defects.
171
What transposition flap restores the frontal hairline?
Juri flap.
172
Where is the frontal branch of VII most vulnerable during brow lift?
Just above the lateral brow, 1-2 em from the orbital rim.
173
What sort of plates should be used in the severely atrophic mandible?
Large reconstruction plates.
174
What sort of plates should be used with comminuted mandible fractures?
Large reconstruction plates.
175
In cases ofpanfacial fractures, when should NOE fractures be repaired?
Last.
176
What is the primary complication of the temporal advancement flap for reconstruction of the anterior lamella of the eyelid?
Lateral canthal droop.
177
For full-thickness defects of the eyelid that cannot be closed primarily, what technique is attempted prior to using any flaps?
Lateral cantholysis.
178
What can be done to improve exposure with the transconjunctival approach?
Lateral canthotomy with cantholysis.
179
What are the various interrupted strip techniques?
Lateral division, medial division, multiple vertical interrupting cuts, both medial and lateral division with a resection of a lateral segment, and rotation of a segment of lateral crus into medial crus.
180
Where should the medial incision be placed when raising the pectoralis major flap?
Lateral to the perforating branches of the internal mammary artery to preserve the blood supply of a deltopectoral flap should it be needed in the future.
181
Which musculocutaneous flap has the largest area of skin available for transfer to the head and neck?
Latissimus dorsi.
182
What is the primary blood supply of the latissimus dorsi flap?
Latissimus dorsi-Thoracodorsal artery.
183
What procedure is normally performed prior to extensive scalp reductions?
Ligation of the occipital vessels 2-6 weeks before the reduction.
184
What are miniplates?
Lightweight, compression-neutral plates designed to be used with self-tapping screws (2.0 mm, 1.5 mm, or 1.3 mm).
185
What is the consequence of overly aggressive resection of upper eyelid skin?
Loss of crease definition.
186
What are the relative contraindications to the coronal forehead lift?
Male-pattern baldness in men and high hairlines in women.
187
How is midface retrusion treated?
Maxillary advancement through LeFort osteotomies.
188
Which technique is ideal for patients with an overprojected tip due to overdeveloped alar cartilages?
Medial and lateral division with resection of lateral segment.
189
What techniques can be used to augntent the effects of the complete strip, without sacrificing tip projection?
Medial triangle excision, alternating incomplete incisions, crosshatching, gentle morselization, and transdomal suture narrowing.
190
Which patients are good candidates for the midforehead lift?
Men with deep rhytids in whom a coronal lift is contraindicated.
191
What is the primary complication of this flap?
Microstomia.
192
What are the two most common complications of dermabrasion?
Milia and hypopigmentation.
193
What types of screws are used to secure superiorly positioned plates?
Monocortical to prevent damage to tooth roots.
194
What are the advantages of the subciliary approach?
More direct, requires less understanding of orbital anatomy, and provides more exposure than the transconjunctival approach.
195
How do chin implants used in women differ from those used in men?
More oval in women, squarer and larger in men.
196
What is the advantage of leaving a small amount of soft tissue on the auricular graft?
More rapid host bed fixation.
197
What technique involves placing several horizontal mattress sutures along the scapha to create an antihelical sulcus?
Mustarde technique.
198
What is the role of angiography prior to fibula free flap?
Necessary to confirm the presence of the peroneal artery and to confirm that it is free of disease and not the dominant source of blood supply to the distal leg.
199
What is the difference in outcome between these approaches?
No significant difference in outcome.
200
When should lid malposition after blepharoplasty be corrected?
No sooner than 6 months after the initial surgery.
201
What are the advantages of the Gillies approach?
No visible scar, protects the temporal branch of the facial nerve, and allows bimanual reduction.
202
What are the advantages and disadvantages of the intraoral approach to chin implantation?
No visible scars; increased potential for contamination; suture line irritation; requires larger incision than the external approach; unable to stabilize the implant internally.
203
What should be done if bony resorption occurs under the implant?
Nothing.
204
4 weeks after ORIF of a mandibular body fracture, your patient presents with an exposed plate and purulent drainage. The reduction is grossly intact. 'What do you do?
Open wound, remove involved tooth if applicable, remove hardware, and assess union; if nonunion is present, most patients will heal with MMF; other option is plate and bone graft (external approach).
205
10 days after ORIF of a mandibular body fracture, your patient presents with an exposed plate and purulent drainage. The reduction is grossly intact. What do you do?
Open wound, remove involved tooth if applicable; if hardware is loose, replace it with a new plate; if hardware is rigid, continue drainage, wound care.
206
What is the primary advantage of the Karapandzic circumoral rotation flap?
Orbicularis oris muscle is preserved.
207
What would be the optimal treatment for a 25-year-old man with a LeFort I fracture, bilateral dislocated subcondylar fractures, and a comminuted left parasymphyseal fracture?
ORIF of the parasymphyseal fracture, ORIF of one subcondylar fracture, and MMF for 3 weeks.
208
What is the preferred donor site for bone grafting in the repair of nasoethmoidal (NOE) fractures?
Outer or inner table of the parietal skull.
209
What is the most common cause of alar margin elevation?
Overaggressive resection of the lateral crus.
210
'What problem may arise in the edentulous, denture-wearing patient after mandible fracture with mental nerve disruption?
Patients who wear a complete mandibular denture require gingival sensation; in the presence of bilateral mental nerve paresthesia, it may be impossible for the patient to tolerate a mandibular denture.
211
What is the primary blood supply to the Fibular free flap?
Peroneal artery.
212
What is the most effective treatment for entropion that fails to resolve with massage?
Placement of a spreader graft (i.e., palatal mucosal graft) in the posterior lamella.
213
What is the most common complication of segmental mandibulectomy defect reconstruction with plates?
Plate exposure.
214
'What is the most common complication of segtnental mandibulectomy defect reconstruction with plates?
Plate exposure.
215
What is the primary blood supply of the pectoralis major muscle (PMM) flap?
PMM-Thoracoacromial, lateral thoracic arteries.
216
Which injectable filler is approved by the FDA for treatment of lipoatrophy in HIV patients?
Poly-L-lactic acid (Sculptra).
217
What is the most common cause of infection after ORIF?
Poor plating technique.
218
Where should the point of attachment of the medial canthal tendons be directed?
Posterior and superior to the lacrimal fossa to avoid telecanthus and blunting of the medial canthal area.
219
In which plane is the neck dissected during deep plane rhytidectomy?
Preplatysmal.
220
What are the two transconjunctival approaches?
Preseptal and retroseptal.
221
In what direction are the flaps pulled during SMAS suspension?
Primarily superiorly and partially posterior.
222
What are the mild complications of laser skin resurfacing?
Prolonged erythema, acne or milia, contact dermatitis, and pruritus.
223
What factors predispose to lid malposition after lower lid blepharoplasty?
Proptosis or unilateral high myopia; preexisting scleral show; malar hypoplasia; lower lid laxity from previous surgery; and females \> 65 years and all males.
224
What are the advantages to the preseptal approach?
Protection of the inferior oblique muscle and periorbita.
225
What is the most important surgical component of the septum?
Quadrangular cartilage-provides midline support and can significantly influence the external appearance of the nose.
226
What is the optimal flap for oral cavity soft tissue defects?
Radial forearm free flap (RFFF).
227
What factors significantly increase the risk of plate exposure?
Radiation therapy and extensive soft-tissue resection.
228
How is stabilization by splinting performed?
Reconstruction plates with bicortical screws.
229
What if the skull base is involved?
Reconstruction requires microsurgery with a latissimus dorsi, rectus abdominus, or free omental flap.
230
What are the advantages of lateral interruption techniques?
Reduced likelihood of uneven tip-defining points becoming evident months after surgery; faster symmetrical healing; less loss of projection; avoidance of notching and pinching.
231
What are two major limitations of the transconjunctival approach to lower lid blepharoplasty?
Redundant skin cannot be removed and orbicularis hypertrophy cannot be treated.
232
What factors increase the risk of prolonged erythema?
Regular use of tretinoin or glycolic acid, rosacea, multiple passes, inadvertent pulse stacking, aggressive intraoperative rubbing.
233
What is the treatment for infected extraoral mandibular ORIF?
Removal of the tooth and the failed plate, debridement of dead bone, placement of a large reconstruction plate, and primary grafting if inadequate bone contact exists.
234
How can one repair a floating palate when the anterior and lateral walls of the maxilla are severely comminuted?
Replace the comminuted bone with a bone graft fixed to the alveolar ridge and infraorbital rim.
235
What are the advantages of using a nondelivery approach?
Requires minimal dissection ensuring more symmetric and predictable healing; resists cephalic rotation; single incision; preserves existing tip projection; and resists tip retrodisplacement and postoperative tip ptosis.
236
What is the primary disadvantage of this procedure?
Requires 6-8 weeks of ocular occlusion.
237
What are the two types of lower lid malposition after blepharoplasty?
Retraction and ectropion.
238
What is the difference between retraction and ectropion?
Retraction is vertical lid shortening due to fibrosis in the middle lamellar plane; ectropion is lid eversion caused by shortening of the anterior lamella, skin, and orbicularis oculi.
239
Which is more common?
Retraction.
240
What is the most severe, yet rarest, complication of blepharoplasty?
Retrobulbar hemorrhage-incidence 0.04%.
241
Which of these involves an incision in the fornix directly into the orbital fat?
Retroseptal.
242
What problem can occur with overzealous tightening of the superior and inferior third of the ear?
Reverse telephone ear.
243
What are the best reconstructive options for total lip defects?
RFFF, groin flap, or scapular flap.
244
What is usually the last surgery performed in children with clefts?
Rhinoplasty.
245
Which of these techniques is best for thick-skinned patients with abundant soft tissue and a wide, underprojected tip?
Rotation of a segment of lateral crus into the medial crus.
246
What techniques can be used to decrease tip projection?
Sacrifice of major tip support mechanisms, reduction of a large nasal spine, resection of a small amount of cartilage from the lateral alar crus, softening the domes by serial crosshatching, reduction of overdeveloped cartilaginous dorsum.
247
What is the primary blood supply of the sternocleidomastoid myocutaneous (SCM) flap?
SCM-Random (occipital, superior thyroid, transverse cervical arteries).
248
What must be done prior to autologous condyle transplantation?
Scrapings of the marrow cavity at the cut end should be sent for frozen section to confirm that it is free of tumor.
249
What is the primary advantage of AlloDerm?
Semipermanent (20-50% persistence beyond 1year).
250
In the delivery approach, what are the indications for using a complete, rather than hemi-, transfixion incision?
Severely deviated caudal septum; when access to the nasal spine is necessary; when tip rotation and nasal shortening are desired.
251
What factors are associated with decreased skin paddle survival?
Short skin island, short bone graft, use of the skin paddle intraorally.
252
What is the primary disadvantage to the preseptal approach?
Slightly higher risk of lower-lid entropion.
253
When should a posterior incision be used to harvest auricular cartilage?
Small grafts and when epithelial and soft tissues are to be incorporated with the graft.
254
What are the three techniques most often used for unilateral cleft lip repair?
Straight line repair, Tennison triangular flap repair, and Millard rotation advancement flap.
255
In which plane is the midface dissected during deep plane rhytidectomy?
Subcutaneous for 2-3 em anterior to the tragus, then immediately superficial to the orbicularis and zygomaticus muscles.
256
What is the plane of dissection in the coronal forehead lift?
Subgaleal.
257
What are the approaches to ORIF of condylar fractures?
Submandibular or retromandibular (most common); intraoral; preauricular facelift incision
258
What is the major vascular pedicle for the platysma myocutaneous flap?
Submental branch of the facial artery.
259
In which plane is the lower face dissected during deep plane rhytidectomy?
Sub-SMAS plane.
260
What should be used to prevent this problem?
Sunscreen (pretreatment regimens have not been proven to help).
261
What is the blood supply to this flap?
Superficial temporal artery.
262
The "zone of tension" refers to which area of the mandible?
Superior border of the mandible.
263
What muscle is primarily responsible for preventing velopharyngeal insufficiency (VPI)?
Superior constrictor muscle.
264
What are the two techniques for pharyngoplasty?
Superior-based pharyngeal flap and sphincter pharyngoplasty.
265
A patient presents to you with TMJ ankylosis after repair of a condylar fracture. 'What should be done?
Surgical correction (interpositional arthroplasty, costochondral grafting, total joint prosthesis) followed by vigorous physical therapy.
266
How should an outbreak of HSV be treated?
Switch to a different antiviral and administer the maximum dose.
267
What technique is ideal for reconstruction of posterior lamellar defects of the upper lateral eyelid?
Tarsal rotation flap.
268
What are the disadvantages of using a nondelivery approach?
Technically more difficult if inexperienced.
269
What are the indications for extraction of teeth in mandibular fracture lines?
Teeth that are grossly mobile, have fractured roots, have advanced dental caries and periapical pathology, have soft-tissue pathology, or that hinder fracture reduction.
270
What complication is caused by too much flexion of the midportion of the antihelix and inadequate flexion at the superior and inferior poles?
Telephone ear.
271
In what region of the face can transection of the SMAS directly injure a branch ofVII?
Temporal region.
272
Where should the chin implant lie in relation to the lower incisors?
The anterior surface should not lie beyond the labial surface of the lower incisors.
273
What is the basic method of the converse technique?
The antihelix is created using an island of cartilage.
274
What should be done if the distal portion of the canaliculus is resected?
The cut end should be marsupialized and stented for at least 3 weeks.
275
How much auricular cartilage can be harvested without affecting the structural integrity of the ear?
The entire concha can be removed as long as the antihelix is kept intact.
276
What tissues are included in the posterior thigh fasciocutaneous flap?
The fascia lata, subcutaneous tissue, and the descending branch of the inferior gluteal artery.
277
What is the difference between the hemitransfixion incision and the Killian incision?
The hemitransfixion incision is made unilaterally at the junction of the caudal septum and the columella, whereas the Killian incision is made unilaterally 2-3 mm cephalic to the mucocutaneous junction.
278
In a Millard repair, which part of the lip is rotated and which is advanced?
The medial segment is rotated inferiorly, and the lateral segment is then advanced medially.
279
After MMF for a condylar fracture, your patient complains of deviation ofhisjaw on opening. 'What should be done?
The patient should look in the mirror while opening the jaw and practice forcing himself to open without deviation. The deviation can be overcome with these exercises.
280
How is closed reduction achieved in edentulous patients?
The patient's dentures are wired to his or her jaws using circummandibular and circumzygomatic wires or screws. Gunning splints are used if dentures are not available.
281
When dissecting from the temporal region to the zygomatic arch, where does the deep temporal fascia divide into superficial and deep layers?
The temporal line of fusion at the level of the superior orbital rim.
282
What happens to the fascia as dissection continues toward the zygomatic arch?
The temporoparietal fascia and the superficial layer of the deep temporal fascia fuse 1cm above the zygomatic arch.
283
What are the two most common methods of secondary cleft palate repair?
The V-Y advancement and the double reversing Z-plasty.
284
Which is best for clefts extending into the hard palate?
The V-Y advancement.
285
What are the risk factors for developing bossae or horns after rhinoplasty?
Thin skin, strong cartilages, and bifidity.
286
Which patients are good candidates for direct brow lift?
Those with brow asymmetries (i.e., from facial nerve paralysis) and marked ptosis of the lateral eyebrow.
287
Between which muscles does the peroneal artery run?
Tibialis posterior and soleus muscles.
288
What are THORPs?
Titanium hollow screw reconstruction plates.
289
What are AOs?
Titanium or steel fixation plates that are more malleable than THORPs.
290
Why should extra caution be taken during lateral dissection of the upper eyelid?
To avoid prolapsing the lacrimal gland.
291
What is the purpose of lip adhesion?
To facilitate definitive repair by decreasing the tension across the wound.
292
What is the purpose of IMF after Fibular free flap placement?
To minimize movement near the vascular pedicle.
293
What are the two types of nondelivery approaches?
Transcartilaginous and retrograde.
294
What are the disadvantages of the open approach?
Transcolumellar external scar; risk of disturbing normal anatomy in the infratip lobule and caudal aspects of the alar cartilages; prolonged edema in thick-skinned patients; potential for excess trauma to the tip and dorsal skin flap; increased operative time; increased difficulty in judging the exact tip-supratip relationship after skin flap replacement; grafts must be suture fixated.
295
What are the three approaches to the inferior orbital rim/orbital floor?
Transconjunctival, subciliary, and rim incisions.
296
Which approach to the inferior orbital rim involves cutting the capsulopalpebral fascia?
Transconjunctival.
297
What maneuver can be done to help prevent this complication?
Transdomal suture to narrow the tip.
298
What is the primary blood supply of the trapezius flap?
Trapezius-Occipital or transverse cervical arteries.
299
What is the indication for reduction of coronoid process fractures?
Trismus secondary to impingement of the fractured fragment on the zygoma.
300
True/False: After mental nerve injury, sensation usually returns even without repair.
True.
301
True/False: Auricular cartilage grafts can be used to reconstruct the posterior lamella of the lower eyelid but should not be used in the upper eyelid.
True: Placement in the upper lid can cause corneal abrasions.
302
What is the optimal flap for reconstruction of pharyngoesophageal defects?
Tubed RFFF or free jejunal (RFFF is better for base of tongue or oropharynx, free jejunal flap is better for total pharyngoesophagectomies).
303
Which of these has a potentially higher fistula rate?
Tubed RFFF.
304
What is the most common repair for complete unilateral cleft palate?
Two flap palatoplasty, described by Bardach and Slayer.
305
What does "dynamic compression" refer to?
Two-plate system (compression and tension plates).
306
What are the disadvantages of the Abbe-Sabattini flap?
Two-staged procedure, risk of patient injuring the flap by opening the mouth too widely, and risk of microstomia.
307
What percent of patients pharyngoplasty to reduce VPI?
Up to 20%. with cleft palate eventually require pharyngoplasty
308
How long does Sculptra last?
Up to 3 years.
309
What is the most appropriate approach for exposure of the inferior maxillary buttresses?
Upper labial buccal sulcus incision.
310
What are the advantages and disadvantages of medial interruption techniques?
Useful in more extreme anatomic situations to normalize tip projection but almost always result in a moderate to major loss of tip projection and have the potential for notching and pinching.
311
What are the indications for surgical exploration after ZMC injury?
Visual compromise, EOM entrapment, globe displacement, significant orbital floor disruption, displaced or comminuted fractures.
312
When is stabilization by splinting performed?
When compression is impossible (e.g., inadequate fracture surface area, atrophic edentulous fractures, comminuted fractures, and defect fractures).
313
When are bone grafts used in the repair of anterior table fractures?
When gaps \>4-S mm are present.
314
After high-energy avulsion injuries to the face, when is reconstruction of missing bone and soft tissue initiated?
When no further necrosis is seen at reexploration of the wound.
315
When is a cleft lip normally repaired?
When the child is 10 weeks old, weighs 10 lbs, and has a hemoglobin of 10 ("rule of 1os"); this is delayed 4 months if lip adhesion is first performed.
316
What complication results from pulling too far posteriorly?
Widening and flattening of the oral commissure.
317
What are the advantages to the open approach?
Wider exposure, allowing the use of binocular vision, bimanual dissection, and microcautery for hemostasis; enables direct vision of the domes and the nasal profile; and can secure tip grafts directly with suture and approach the septum from above-down as well as from below-up.
318
What are the advantages of using miniplates over wires in reducing fractures of the ZMC?
Wires only stabilize in the x plane, whereas miniplates add stabilization in all three spatial planes (x) y, z); wires are difficult to place in free-floating pieces of bone; wires require exposure of the deep surface of the bone.
319
How can extensive midface defects involving the orbit and/or maxilla be reconstructed?
With a prosthesis or latissimus dorsi flap with multiple skin paddles.
320
What is the difference in the mechanism of healing between facial fractures repaired with MMF and fractures repaired with ORIF?
With MMF, a callus, formed via micromovement of the fractured ends, bridges the fractured ends together; with ORIF, no callus is formed, and the fracture heals via direct bone growth.
321
What is the proper plane of dissection in the temporal region to avoid injury to VII?
Within the subaponeurotic plane (deep to the temporoparietal fascia).
322
What is the safest plane of dissection in the temporal region when exposure of the zygomatic arch is necessary?
Within the superficial temporal fat pad deep to the superficial layer of the deep temporal fascia.
323
Which patients are good candidates for the pretrichial forehead lift?
Women with a high hairline and long vertical height to the forehead.
324
Which patients are not good candidates for endoscopic brow lift?
Women with high hairlines, patients with male-pattern baldness or tight, thick skin with extensive bony attachments (more common in Asians and native Americans).
325
Reduction of which buttresses is essential to restore the midfacial length?
Zygomaticomaxillary and nasomaxillary buttresses.
326
Generally, what size defects of the lower lip can be closed primarily
\< 1/2 the lip.
327
When is the risk of thrombosis highest after microsurgical reconstruction
15 - 20 minutes after closure.
328
Where does the common tibial-peroneal trunk originate in relation to the head of the fibula
2 - 7 em distal.
329
If IMF is used, when is it removed
2 weeks postoperatively.
330
How long does it take for complete regeneration of the endothelium across a microvascular anastomosis
2 weeks.
331
What is the average length of the fibula
25 em.
332
What is the maximum size of graft that can safely be obtained in-situ
3 - 4 em wide.
333
Where should dissection of the tarsoconjunctival flap begin in relation to the lid margin
3 - 4 mm superior to the lid margin.
334
What is the maximum length to width ratio for local flaps
3: I.
335
What is the most common complication from microsurgical reconstruction
36% suffer medical complications (pulmonary problems, prolonged ventilatory support, acute ethanol withdrawal).
336
What antibiotics is this organism sensitive to
3rd -generation cephalosporins, ciprotloxacin, aminoglycosides, sulfa drugs, and tetracycline.
337
In institutions performing high volume microsurgical reconstruction, what is the success rate? Re-exploration rate
98%; 2%.
338
What should be incorporated into the flap to promote viability of the skin paddle
A small cuff of soleus and flexor hallicus longus muscle.
339
What is the best method of reconstruction for defects between 112 to 2/3 of the lower lip, not involving the oral commissure
Abbe-Sabattini flap.
340
What organism lives in the gut of leeches and is the most common organism associated with wound infections when leeches are applied
Aeromonas hydrophila.
341
What is the minimum age at which the calvarium can be split
Age 4 or 5 (layers of the skull are not defined until then).
342
On average, how much skin is perfused by the peroneal artery in the FFF
Approximately I 0 x 2 I em.
343
What are the contraindications to leech use
Arterial insufficiency, severe immunocompromise, allergic reaction to previous leech application.
344
Where should the vascular pedicle lie on the new mandible
As close as possible to the new mandibular angle.
345
Which method is optimal
Autologous condyle transplantation as it preserves occlusion, TMJ function, and vertical facial height without increasing morbidity.
346
How wide are the Burow's triangles designed
Bases are equal in width to I /2 of the lip defect.
347
What is the best method of reconstruction for defects involving 2/3 or more of the upper lip
Burow-Dieffenbach +/Abbe-Sabattini flap.
348
What if the skull is involved
Can use a split calvarial, split rib, or methyl methacrylate plus latissimus dorsi flap.
349
Why should a rhomboid flap not be used to close a scalp defect
Causes improper orientation of the hair.
350
What is a V-Y advancement
Closure of a rectangular defect by incising an adjacent triangle of tissue and advancing it into the defect.
351
How is the diploic layer of the skull recognized during in-situ harvesting
Color changes from yellow-white to red and increased bleeding occurs.
352
How does delaying (elevating the flap in 2 stages 2-3 weeks apart) improve flap survival
Conditions tissue to ischemia, closes A-V shunts, and increases blood flow by sympathectomy.
353
What problems can occur if a lateral mandibular defect is not reconstructed
Contour deformity of the lateral lower 1 /3 of the face, displacement of residual mandible toward the side of the defect, malocclusion.
354
Why do cranial bone grafts have superior resistance to resorption when compared to other donor sites (eg, rib or iliac bone)
Cranial bone originates from membranous bone whereas the other donor sites originate from endochondral bone; cranial bone revascularizes more quickly.
355
What technique is ideal for repair of large full-thickness defects of the upper lid
Cutler Beard or Bridge procedure.
356
What vessels is the iliac crest free flap based on
Deep circumflex iliac vessels.
357
What vessels is the rectus abdominus free flap based on
Deep inferior epigastric vessels.
358
What is the primary blood supply to the temporalis muscle flap
Deep temporal artery.
359
What is the primary blood supply of the deltopectoral, temporal, forehead, and nape of neck cutaneous flaps
Deltopectoral - internal mammary arteries. Temporal - superficial temporal artery. Forehead - supraorbital and supratrochlear arteries. Nape of neck - random (postauricular, occipital vertebral arteries).
360
What finding on inspection of a flap signifies venous thrombosis
Development of a sharp line of color demarcation.
361
What is the major limit of microsurgical reconstruction in this area
Difficult to restore normal contour.
362
What are the major limitations of microsurgical reconstruction in the head and neck
Difficult to restore texture/color of facial skin, soft tissue/bony contour of maxilla, functional mobility of tongue/lower lip, and sensation of oral cavity.
363
What complications are specific to the cranial bone harvest
Dural exposure, meningitis, CSF leak, sagittal sinus injury, and brain injury.
364
The greater omentum axial flap is based on what vessels
Either the right or the left gastroepiploic artery.
365
Which rotation flap is best suited for lateral defects of the lower lip
Estlander flap.
366
What is the best flap for defects of the oral commissure
Estlander flap.
367
What is the primary advantage of the eyelid margin graft
Eyelash replacement.
368
What 4 composite grafts can provide both rigidity and a mucosal surface for eyelid reconstruction
Eyelid margin graft, tarsoconjunctival graft, nasal chondromucosal graft, hard palate mucoperiosteal graft.
369
To which vessels can the peroneal artery be anastomosed
Facial or external carotid artery.
370
What is the best material for dural reconstruction
Fascia lata.
371
What is the optimal flap for reconstruction of anterior mandibular defects
Fibular free flap (FFF).
372
What are the best flaps for through-and-through cheek or oral cavity defects
Folded RFFF or double paddle scapula flap.
373
What is the primary advantage of using a soft tissue free flap over a pectoralis major flap in conjunction with a mandibular plate
Free flap results in a much lower rate of plate exposure.
374
What flaps are ideal for reconstruction of extensive scalp defects
Free latissimus dorsi surfaced with non-meshed split thickness skin graft; if entire scalp is involved, latissimus dorsi with serratus anterior.
375
What are the different types of cranial bone grafts
Full thickness calvarium, split thickness calvarium, bone chips, and bone dust.
376
What factor is most essential to the success of a vascularized bone graft to the mandible
Good immobilization.
377
What is the most potent natural inhibitor of thrombin
Hirudin.
378
What technique is ideal for reconstruction of large posterior lamella defects of the lower lid
Hughes tarsoconjunctival flap.
379
How wide should the Abbe-Sabattini flap be
I /2 the width of the defect.
380
What is the best method of reconstruction for defects involving 2/3 or more of the lower lip
If centered in the midline, the Webster modification of the Bemard-Burow repair.
381
If a free flap fails, what is the best option for reconstruction
If medical condition allows, a second free flap should be performed instead of a locoregional flap.
382
Which of these is most reliable? least reliable
Iliac crest, radius, respectively.
383
Which types of osseous free flaps allow enosseous dental implants
Iliac crest, scapula, fibula, and radius.
384
What are the reconstructive options when the mandibular condyle must be removed during tumor resection
Incompletely reconstruct the ramus so it doesn't extend as high as the glenoid fossa. Attach a prosthetic condyle to the flap. Shape the end of the flap to simulate the condyle. Use the resected condyle as a nonvascularized graft mounted onto the end of the flap with a miniplate.
385
What complications are specific to the iliac crest donor site
Injury to abdominal contents or the ilio-femoral joint, detachment of the inguinal ligament, interference with tensor fascia lata function, or damage to nearby peripheral nerves.
386
What is the term for a flap that is raised from a nearby region and moved to a defect across intact skin
Interpolation flap.
387
Why is the FFF optimal for reconstruction of mandibular defects
It provides enough length to reconstruct any size defect, can be harvested in the supine position and in tandem with tumor resection, has low donor site morbidity, and provides soft tissue for intraoral defects.
388
What is the primary complication of the temporal advancement flap for reconstruction of the anterior lamella of the eyelid
Lateral canthal droop.
389
For full thickness defects of the eyelid that cannot be closed primarily, what technique is attempted prior to using any flaps
Lateral cantholysis.
390
Where should the medial incision be placed when raising the pectoralis major flap
Lateral to the perforating branches of the internal mammary artery to preserve the blood supply of a deltopectoral flap should it be needed in the future.
391
Which musculocutaneous flap has the largest area of skin available for transfer to the head and neck
Latissimus dorsi.
392
For reconstruction of oropharyngeal defects, what are the advantages of using a free flap over a pectoralis major flap
Lower wound complication rate and shorter hospitalization.
393
What is the best way to avoid injury to the superior sagittal sinus during harvesting of calvarial bone
Maintain at least a 2 em distance from the sagittal suture.
394
What is the primary complication of this flap
Microstomia.
395
Which of these are most numerous
Musculocutaneous.
396
What is the role of angiography prior to FFF
Necessary to confirm presence of the peroneal artery and to confirm that it is free of disease and not the dominant source of blood supply to the distal leg.
397
What is the primary advantage of the Karapandzic circumoral rotation flap
Orbicularis oris muscle is preserved.
398
What is the preferred site for harvesting calvarial bone
Parietal bone (anterior for a flat graft; posterior for a curved graft).
399
What is the thickest part of the skull
Parietal bone.
400
What is the primary blood supply to the pectoralis major flap
Perforating arteries of the thoracoacromial artery.
401
What is the primary blood supply to the deltopectoral flap
Perforating branches of the internal mammary artery ( 4 branches, with the 2"d and 3rd branches representing the dominant blood supply).
402
What can be done to minimize the visibility of the bicoronal incision
Perform a wavy line incision.
403
What is the primary blood supply to the FFF
Peroneal artery.
404
What is the typical order of return of sensation in noninnervated flaps
Pinprick, touch, then temperature.
405
What is the most common complication of segmental mandibulectomy defect reconstruction with plates
Plate exposure.
406
What is the primary blood supply of the pectoralis major (PMM), trapezius, latissimus dorsi, and sternocleidomastoid myocutaneous (SCM) flaps
PM M - thoracoacromial, lateral thoracic arteries. Trapezius - occipital or transverse cervical arteries. Latissimus dorsi - thoracodorsal artery. SCM - random (occipital, superior thyroid, transverse cervical arteries).
407
What complications are specific to the rib donor site
Pneumothorax, hemothorax, and intercostal nerve injury.
408
What is the optimal flap for oral cavity soft tissue defects
Radial forearm free flap ( RFFF).
409
What are the best reconstructive options for total lip defects
Radial forearm free flap, groin flap, or scapular flap.
410
What factors significantly increase the risk of plate exposure
Radiation therapy and extensive soft-tissue resection.
411
What if the skull base is involved
Reconstruction requires microsurgery with latissimus dorsi, rectus abdominus, or free omental flap.
412
What is the primary disadvantage of this procedure
Requires 6 - 8 weeks of ocular occlusion.
413
Considering rotation flaps, myocutaneous flaps, and random flaps, which of these has the strongest blood supply
Rotation flap.
414
Where is this substance found in nature
Salivary glands of leeches.
415
What must be done prior to autologous condyle transplantation
Scrapings of the marrow cavity at the cut end should be sent for frozen section to confirm that it is free of tumor.
416
Which of these supplies the most blood to the skin
Septocutaneous.
417
What factors are associated with decreased skin paddle survival
Short skin island, short bone graft, use of the skin paddle intraorally.
418
What is the thinnest part of the skull
Squamous portion of the temporal bone.
419
What is the major vascular pedicle for the platysma myocutaneous flap
Submental branch of the facial artery.
420
What technique is ideal for reconstruction of posterior lamellar defects of the upper lateral eyelid
Tarsal rotation flap.
421
What should be done if the distal portion of the canaliculus is resected
The cut end should be marsupialized and stented for at least 3 weeks.
422
Through which muscle compartment do the musculocutaneous branches course
The deep posterior compartment containing the soleus and flexor hallicus longus muscles.
423
What is the blood supply of a random flap
The dermal and subdermal plexuses.
424
What tissues are included in the posterior thigh fasciocutaneous flap
The fascia lata, subcutaneous tissue and the descending branch of the inferior gluteal artery.
425
What is the primary blood supply to this flap
Thoracodorsa] artery.
426
Between which muscles does the peroneal artery run
Tibialis posterior and soleus muscles.
427
What are THORPs
Titanium hollow screw reconstruction plates.
428
What are AOs
Titanium or steel fixation plates that are more malleable than THORPs.
429
What is the purpose of IMF after FFF placement
To minimize movement near the vascular pedicle.
430
What is the term for a flap that is raised and pivoted into a defect, leaving a secondary defect that must be repaired
Transposition flap.
431
What is the primary blood supply to the trapezius flap
Transverse cervical artery.
432
T/F: Axial flaps are more reliable than random flaps
True.
433
T/F: The surviving length of an axial pattern flap remains constant regardless of flap width
True.
434
T/F: Sagittally oriented scalp incisions tend to cause less scalp sensory disturbance than do coronally oriented incisions
True.
435
T /F: Significant return of sensation to a free flap occurs even in the absence of neural anastomosis. True.
True.
436
T/F: Auricular cartilage grafts can be used to reconstruct the posterior lamella of the lower lid but should not be used in the upper lid
True; placement in the upper lid can cause corneal abrasions.
437
What is the optimal flap for reconstruction of pharyngoesophageal defects
Tubed RFFF or free jejunal (RFFF is better for base of tongue or oropharynx, free jejunal flap is better for total pharyngoesophagectomies).
438
Which of theses has a potentially higher fistula rate
Tubed RFFF.
439
What are the disadvantages of the Abbe-Sabattini flap
Two-staged procedure, risk of patient injuring the flap by opening the mouth too widely, and risk of microstomia.
440
What are the 3 different types of skin branches off the peroneal artery
Type A: musculocutaneous. Type 8: musculocutaneous and septocutaneous. Type C: septocutaneous.
441
How can extensive midface defects involving the orbit and/or maxilla be reconstructed
With a prosthesis or latissimus dorsi flap with multiple skin paddles.
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